Li Dennis H, Zamantakis Alithia, Zapata Juan P, Danielson Elizabeth C, Saber Rana, Benbow Nanette, Smith Justin D, Swann Gregory, Macapagal Kathryn, Mustanski Brian
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
Implement Sci Commun. 2024 Aug 27;5(1):91. doi: 10.1186/s43058-024-00628-2.
Despite being the primary setting for HIV prevention among men who have sex with men (MSM) since the start of the epidemic, community-based organizations (CBOs) struggle to reach this historically stigmatized and largely hidden population with face-to-face interventions. HIV researchers have readily turned to the internet to deliver critical HIV education to this group, with evidence of high effectiveness and acceptability across studies. However, implementation outside of research contexts has been limited and not well studied. We aimed to assess HIV CBOs' readiness to adopt digital health interventions and identify contextual factors that may contribute to differing levels of readiness.
We recruited 22 CBOs across the US through a pragmatic request-for-proposals process to deliver Keep It Up! (KIU!), an evidence-based eHealth HIV prevention program. We used mixed methods to examine CBO readiness to adopt digital health interventions (RADHI). Before implementation, CBO staff completed a 5-item RADHI scale (scored 0-4) that demonstrated concurrent and predictive validity. We interviewed CBO staff using semi-structured questions guided by the Consolidated Framework for Implementation Research and compared RADHI score groups on determinants identified from the interviews.
Eighty-five staff (range = 1-10 per CBO) completed the RADHI. On average, CBOs reported moderate-to-great readiness (2.74) to adopt KIU!. High RADHI CBOs thought KIU! was a top priority and an innovative program complementary to their existing approaches for their clients. Low RADHI CBOs expressed concerns that KIU! could be a cultural mismatch for their clients, was lower priority than existing programs and services, relied on clients' own motivation, and might not be suitable for clients with disabilities. Value, appeal, and limitations did not differ by RADHI group.
While HIV CBOs are excited for the opportunities and advantages of digital interventions, additional pre-implementation and implementation support may be needed to increase perceived value and usability for different client populations. Addressing these limitations is critical to effective digital prevention interventions for HIV and other domains such as mental health, chronic disease management, and transitions in care. Future research can utilize our novel, validated measure of CBOs' readiness to adopt digital health interventions.
NCT03896776, clinicaltrials.gov, 1 April 2019.
自艾滋病流行开始以来，尽管社区组织一直是男男性行为者（MSM）预防艾滋病的主要场所，但这些组织在通过面对面干预措施接触这个历史上受到污名化且很大程度上隐匿的人群方面面临困难。艾滋病研究人员已欣然转向互联网，为该群体提供关键的艾滋病教育，多项研究证明其具有很高的有效性和可接受性。然而，在研究背景之外的实施情况有限且研究不足。我们旨在评估艾滋病社区组织采用数字健康干预措施的准备情况，并确定可能导致不同准备程度的背景因素。
我们通过务实的提案征集程序在美国招募了22个社区组织，以提供“坚持下去！”（KIU！）这一基于证据的电子健康艾滋病预防项目。我们采用混合方法来检查社区组织采用数字健康干预措施的准备情况（RADHI）。在实施之前，社区组织工作人员完成了一个包含5个项目的RADHI量表（得分0 - 4），该量表显示出同时效度和预测效度。我们使用由实施研究综合框架指导的半结构化问题对社区组织工作人员进行访谈，并比较了根据访谈确定的决定因素上的RADHI得分组。
85名工作人员（每个社区组织1 - 10人）完成了RADHI。平均而言，社区组织报告采用KIU！的准备程度为中等至很高（2.74）。RADHI得分高的社区组织认为KIU！是首要任务，是对其现有针对客户的方法的一种创新补充。RADHI得分低的社区组织表示担心KIU！可能与他们的客户存在文化不匹配，比现有项目和服务的优先级低，依赖客户自身的积极性，并且可能不适用于残疾客户。价值、吸引力和局限性在RADHI得分组之间没有差异。
虽然艾滋病社区组织对数字干预措施的机会和优势感到兴奋，但可能需要额外的实施前和实施支持，以提高不同客户群体对其感知价值和可用性。解决这些限制对于艾滋病以及心理健康、慢性病管理和护理过渡等其他领域的有效数字预防干预至关重要。未来的研究可以利用我们新的、经过验证的衡量社区组织采用数字健康干预措施准备情况的方法。
NCT03896776，clinicaltrials.gov，2019年4月1日。
